High colonic therapy instrument



March 10, 1936. N. B. SALERNI 2,033,652

HIGH COLONIC THERAPY INSTRUMENT original F11ed Aug. :51, 1951 2snees-sneet 1 March 10, 1936. N, B- SALERNI l33,652

HIGH COLONIC THERAPY INSTRUMENT Original FiledAug. 3l, 1951 2Sheets-Sheet 2 [fz ven/for,

Patented Mar. 10, 1936 UNITED STATES PATENT GFFICE Application August31, 1931, Serial No. 560,298 Renewed June 2, 1934 17 Claims.

The object of this invention is to provide a rectal expanding nozzlewith a suitable valve, which will give the maximum of results in theirrigation of any body cavity, human or animal,

or cavity of any sort or nature not necessarily confined to the animalor human body.

A further object is to provide an expanding nozzle which will so fit anycavity as to cause an automatic retention of the nozzle in place, sothat m there is no danger of its slipping out to release fecal matter tosoil garments and linen or discharge odors in the treatment room.

The object, further, is to increase the diameter of the' bore of thenozzle to provide a greater reg turn flow or drainage, which is a mostimportant part in irrigation, particularly of the colon.

A further object is to provide an instrument of medium initial diameterfor introduction in the rectum because of the contraction of thesphincgfj ter muscle caused by such introduction and an instrument whichcan be manipulated to enlarge the diameter after a few minutes insertionto conform with the relaxed condition of that muscle which alwaysfollows, and by such enlargement of the instrument prevent the escape ofmatter around it from the bowels, particularly when the colon or cavityis distended with an injected fluid.

A further object is to provide such valve control over the instrumentthat the operator can completely close all flow therethrough, open foran intake flow only, or for an out drain only, or for simultaneousintake and drainage as for continuous irrigation.

I accomplish the above and other objects which will hereinafter appear,by the mechanisml illustrated in the accompanying drawings, in whichFig. l is a View in side elevation and partial longitudinal section atplaces to show the internal structure of one form. of my instrumentshowing a rotary expansible nozzle.

Fig. 2 is a cross section on the line 2 2 of Fig. 1.

Fig. 3 is a side elevation and partial section of a modified form ofinstrument showing a nonexpansible nozzle and colon tube locatedexternally of the cylinder.

Fig. 4 is a cross section on the line 4 4 of Fig. 3.

Fig. 5 is a side elevation of a second modified form with an expansiblenozzle which is expanded by internal pressure.

Fig. 6 is an end view of the instrument looking at'the end opposite thenozzle.

Fig. 7 is a detail in longitudinal section on the line 1 1 of Fig. 5showing the valve gear control.

Fig. 8 is a cross section on the line 8 8 of Fig.

5, and

(Cl. 12S-244) Fig. 9 is a detail in longitudinal section of a modifiedlform of Valve mechanism for my instrument.

Like characters of reference indicate like parts in the several views ofthe drawings.

Referring to Figs. l and 2 of the drawings, the nozzle represented as awhole by the numeral I, is the part that enters the cavity. It isattached to a cylindrical sleeve 2 which is mounted on the end of a body[El and has a rocking adjustment 10 thereon regulated in extent by acircumferential slot 3, through which is passed a screw 4, seated in thebody lll. A regulated adjustment of the sleeve is obtained by a pinion 5engaging a series of indents 6 in the sleeve 2. The pinion is on a 15shaft l extending longitudinally of the body I0 and terminating with amilled wheel 'I' for manipulation. An index 8 on the sleeve 2 points toa scale 9 on the body so that the rotation of the sleeve andaccompanying enlargement or re- 20 duction of the nozzle may be gauged.

An end of the sleeve is finished with a roll in which knobs on the endsof a series of curved wire ribs 3l) are hinged. The ribs` 30 passloosely through holes in a ring 3l xed to the end of thel 25 barrel I ina manner to be fulcrumed in the ring. The ribs are curved or bowedbetween the ring and the distal end of the instrument in a manner tocause the ribs to be spread apart and expanded as a whole by rocking thesleeve 2 in 30 one direction and to be retracted or drawn together whenthe sleeve is rocked in a reverse direction.

Preferably, and as shown in Fig. l, the ribs as a whole are containedwithin a coverr 32, here shown as elastic rubber which stretches andcontracts and folds and unfolds, as the ribs are distended or are drawntogether. The cover at the small end generally folds more or less, asshown by the longitudinal lines, in the reduced form of the nozzle. Anobturator of usual construction (not shown) is used during theintroduction of a rigid nozzle to prevent injury, as shown in Fig. 3.

Referring now to the rest of the instrument, the body or barrel lll hasa cylindrical bore and a slightly tapering end adjacent to the ring 3l.It has a drain nipple ll and an intake nipple l2.

Seated in the barrel l0 is a piston I3 which has a transversediametrical slot I4 in its distal 59 end for drainage purposes. Itterminates outside of the barrel with an enlarged head which is milledfor convenient manipulation in rotating the piston. The piston also hasa circumferential groove which receives a set screw to provide mo- 55tion of rotation without translation, of the piston in the barrel.

Two intake holes I5 and I6, here shown as 90 apart, are provided in thepiston and are connected by a groove as shown by dotted lines in Fig. 1.These holes make connection with the intake nipple I2 of the barrel andselectively with a nipple I'I on the outer end of the piston. The nippleII is in the piston at one side of and parallel with a center hoie I8. Acolon tube I9 is passed through the hole I8 and extends through thenozzle at the distal end of the instrument. A packing gland 20 preventsany back movement of the tube and escape of uid around the. tube fromthe instrument. The tube I9 is continued in a curve and is attached tothe nipple II.

In the operation of my instrument, after the nozzle has been introducedinto the cavity and expanded to a condition of closure to preventleakage, liquid, medicated or not, as desired, is admitted through theintake nipple I2, from any suitable source (not shown) regulated by anysuitable valve (not shown) and by rocking the piston I3, the liquid willpass through the colon tube I9 into the cavity. The discharge throughnipple I I is regulated by a suitable valve, formed by barrel I0 andpiston I3 so that, by opening this valve a flow will occur throughbarrel I El and slot I4 into the nipple II. By properly turning thepiston I3 the intake and outlet may also be closed or opened.

In the modification shown in Fig. 3, the ordinary rigid non-expansiblenozzle is shown just to illustrate that possibility although theexpansible nozzle is preferred. The barrel Il]a has a large drain IIaand two nipples I2a and I2b for intake and discharge, respectively.These are here shown as in a row longitudinally of the barrel, but theymay be separated circumferentially by (not shown). Outside of the barrelis a tube 2| which serves for a holder and passage therethrough of acolon tube I9a which enters the barrel itself near the distal end bybending the barrel in the manner shown. This tube I9au is here locatedat one side of the two nipples, but would pass between them if thenipples were 90 apart circumferentially of the barrel as aboveexplained. The colon tube I9a is attached to the intake nipple I2b, andis passed thence through the pipe 2| and through the nozzle. A pistonI3a has no longitudinal central hole but has a diametrical slot Ma atthe distal end for drainage flow. Two longitudinal channels 22 and 23,90 apart make connection at different adjustments of the barrel, withthe two barrel nipples. A packing gland 24 holds the colon tube in placeand prevents back iiow around it. In the modication shown in Fig. 5, thedistal end of the barrel I0b has an inside corrugation in which a ringis seated to which ring a plurality of wire resilient ribs 30 areattached. These ribs are bent as shown, into the path of a piston I3lowhich has a longitudinal reciprocatory adjustment in the barrel, causingits end to Contact the ribs and spread them apart at their outer ends.The ribs are shown as covered by an elastic rubber cover or shield 60which expands and contracts and folds with the action of the ribs. Theribs may be embedded or otherwise attached to the cover, or the covermay be loose thereon and removable, whereby the ribs may be usedcovered, or uncovered in which latter form the ribs directly contact themembrane of the. cavity in which the instrument is used. The ribs forthe nozzle may be wide for half of their base ends, overlapping eachother (not shown) and narrow at their distal ends and used with orwithout a rubber cover.

It will be seen from foregoing disclosures that I provide a nozzle thatcan be reduced in size for easy introduction and removal and expanded tostop leakage in use, and that the valve construction afords room for alarge discharge. When a colon tube is passed through the customary rigidstraight tube the space around the colon tube is so small that onlyliquids can pass and mucus, seeds, stones, scales, fecal masses hard orsoft cannot pass. This defeats the purpose and causes the patient tostool as soon as the instrument is removed, which is not only Incon-Venient and annoying but discredits the treatment and ability of thedoctor. But with my expanding nozzle, the rectum can be expanded tomaximum as the sphincter relaxes, and a return ow or drainage can beseveral times greater than with the rigid or unexpanding tube. With suchlarge return drain all foreign material as mentioned above will passthrough without any diiiiculty. With no material left behind when thenozzle is withdrawn the rectum is free from irritation and the patientdoes not have to stool immediately as is the case with the unexpandingtube.

The advantage of using one nozzle for all cases, be it children oradults, against three or more of the old unexpanding type., is verygreat and also less expensive.

The simplicity of my nozzle, of either type, makes it easily attachedand removed, easily sterilized like any other surgical instrument orlike rubber gloves. The placing of the rubber cover over the nozzle isas simple as putting on a rubber glove over the hand, and can be done ina few seconds.

The piston is formed with grooves 36 which are engaged by a worm 31 on ashaft 38, mounted in a housing outside of and parallel with the barrel|01. The shaft 38 terminates with a milled wheel by which it is rotatedto impart travel to the piston. The distal end of the piston is hollowback to a transverse diametrical slot Mb, for the free flow of liquidstherethrough, to a drain nipple IIb. The rest of the valve constructionis substantially the same as described for Fig. 3,

and need not be here repeated. In the modifical tion of valve mechanismand control shown in Fig. 9, a barrel I8c has only a drain I IC. Apiston I3c has a slot for the drain, a center passage forv the colontube and a packing gland 20C. A selective valve 25 shown and describedin my copending application controls the uid flow. The piston isreciprocated by mechanism similar to that shown and described for Fig.5.

Having thus fully described my invention in the best form now known tome, what I claim as new and wish to secure by Letters Patent, withoutbeing confined to the exact structure here disclosed more than isrequired by the appended claims,

I claim:

l. In an irrigating nozzle, a plurality of ribs in annular series heldat corresponding ones of their adjacent ends, fulcrumed between theirends and bent between the fulcrums and ends opposite their held ends andmeans coacting with said bends for varying the distance apart and spreadof the ribs at said bends.

2. In an irrigating nozzle, a plurality of bent ribs in annular series,an elastic cover for the ribs and means coacting with the bends of theribs for varying the distance apart of the ribs and for stretching thecover comprising a reciprocating piston movable into contact with thebends.

3. In an irrigating nozzle, a plurality of ribs in annular series heldat corresponding ones of their adjacent ends, ulcrumed between theirends and bent between the fulcrums and ends opposite their held ends andmeans for moving the held ends to rock the ribs for varying the distanceapart of the bent portions comprising a rotatable sleeve in which theheld ends are socketed.

4. In an irrigating nozzle, a plurality of ribs in annular series heldat corresponding ones of their adjacent ends, fulcrumed between theirends and bent between the fulcrums and ends opposite their held ends,and a reciprocating spreader contacting the bends for varying thedistance apart of the last ends, and gear means for accuratelyreciprocating the spreader.

5. In an instrument of the character specified, a barrel having an inletand an outlet nipple and a third nipple, a movable piston in the barrelhaving means ofliquid communication between the inlet nipple and thethird nipple and having a diametrical passage in its distal end adaptedto be brought into communication with the outlet nipple by moving thepiston, a nozzle on the end of the barrel and a colon tube connectedwith the third nipple and discharging through the nozzle.

6. In an instrument of the character specified, a barrel having an inletand an outlet nipple, a third nipple, va movable piston in the barrelhaving means of liquid communication between the inlet nipple and thethird nipple and having a diametrical passage in its distal end adaptedto be brought into communication with the outlet nipple by moving thepiston, a nozzle on the end of the barrel, a colon tube connected withthe third nipple and passing through the piston,

, the barrel and the nozzle.

7. In an instrument of the character specified, a barrel having an inletand an outlet nipple, a third nipple, a movable piston in the barrelhaving means of liquid communication between the inlet nipple and thethird nipple and having a diametrical passage in its distal end adaptedto be brought into communication with the outlet nipple by moving thepiston, a nozzle on the end of the barrel, a colon tube connected withthe third nipple and passing outside of the piston and dischargingthrough the nozzle.

8. In an instrument of the character specied, a barrel having an outletnipple, an expansible nozzle on the distal end of the barrel, areciprocating piston in the barrel having an end adapted to spread thenozzle, said end having a diametrical slot forming part communicationbetween the nozzle and outlet nipple, a colon tube discharging throughthe nozzle valve controlled means for supplying liquid to the tube, andmanually operated means for reciprocating the piston.

9. In an irrigating nozzle, a plurality of ribs in annular series eachheld at corresponding ones of their adjacent ends, said ribs being bentbetween the ends and means coacting with the bends for rotating the ribsabout their held ends for varying the distance apart of their bentportions.

10. In an irrigating nozzle, a plurality of ribs in annular series eachheld at corresponding ones of their adjacent ends, an elastic cover forthe ribs in which the ribs are embedded and which are expanded by theribs and by which the ribs are retracted and means to expand and retractthe cover by moving the ends of the ribs circuitously.

11. In an instrument of the character specied, a barrel having an inletand an outlet nipple, a third nipple, a movable piston in the barrelhaving means of liquid communication between the inlet nipple and thethird nipple and having a passage in its distal end adapted to bebrought into communication with the outlet nipple by moving the piston,the end of said barrel having a discharge opening, a colon tubeconnected with the third nipple and passing through the piston, thebarrel and the barrel discharge opening.

12. In an instrument of the character speciiied, a barrel having aninlet and an outlet nipple and a third nipple, a movable piston in thebarrel having means of liquid communication between the inlet nipple andthird nipple and having a passage in its distal end adapted to bebrought into communication with the outlet nipple by moving the piston,said barrel having an end discharge opening, and a colon tube connectedwith the third nipple and passing out.- side of the piston anddischarging through the barrel discharge opening.

13. A valve having a barrel provided with spaced apart inlet and outletpassages, a shiftable plug in the barrel having at least one pas--sageway adapted to be selectively brought around to providecommunication between said barrel passages and to close off both, saidbarrel being further provided with a drain chamber and an outlet drainpassage, said plug being formed to extend over said drain passage tohave an end directed toward the chamber and being provided with apassage leading from said chamber from which plug passage lateralopenings are provided tol control communication between said drainpassage and said drain chamber, whereby upon suitable shifting of theplug in the barrel, a selection of ows through the valve may be secured,namely, continuous flow between the barrel passages without drain low, acomplete closure of all barrel and drain passages, a continuous flowbetween the barrel passages simultaneously with an open barrel drainpassage, and a closure of the barrel inlet passage with an open drainpassage, said valve being further provided with a passage leading fromsaid barrel outlet passage, and a tube extending from said barrel outletpassage through said drain chamber.

14. A valve having a body provided with spaced apart inlet and outletpassages, a shiftable plug in the body having at least one passagewayadapted to be selectively brought around to provide communicationbetween said body passages and to close oi both, said body being furtherprovided with a drain chamber and an outlet drain passage, said plugbeing formed to extend over said drain passage to have an end directedtoward the chamber and being provided with a passage leading from saidchamber from which plus passage lateral openings are provided to controlcommunication between said drain passage and said drain chamber, wherebyupon suitable shifting of the plug in the body, a selection of owsthrough the valve may be secured, namely, continuous i'low between thebody passages without drain flow, a complete closure of all body anddrain passages, a continuous flow between the body passagessimultaneously with an open body drain passage, and a closure of thebody inlet passage with an open drain passage, and

said body being formed to have a colon tube carrying passage enteringexternally of the body and discharging into said drain chamber wherebythe tube may be inserted and carried through the chamber withoutinterference with the operation of said plug.

15. For an irrigating valve, a body having a central barrel one end ofwhich serves as a drain chamber, an inlet nipple having a passagedischarging within the barrel, and a drain nipple having a passagetherethrough discharging from said chamber, and means on the barrel forreceiving and carrying a tube extending through said chamber.

16. A valve comprising a barrel having an inlet passage and also anoutlet passage, a movable plug in the barrel having at least onepassageway adapted to be selectively presented by the plug to providecommunication between said barrel inlet and outlet passages and to closeoff communication therebetween, said barrel having an opening at itsforward end and also a drain opening removed from the end, said plugextending over said barrel drain opening and also said plug having adrain passage open at the forward end of the plug and opening from theplug side to selectively communicate with the barrel drain opening uponshifting of the plug, and an injecting passageway carried by the barrelleading from said barrel outlet passage to discharge through the openend of said barrel, whereby upon suitable shifting of the plug in thebarrel, a selection of valve controls may be secured namely, aninjecting ow without drain into the barrel inlet passage across the plugpassage and out the barrel outlet passage and through the injectingpassageway out the front end of the barrel, the barrel drain openingbeing closed; an injecting ow with drainage, the ow being the same asthe rst flow but with the plug shifted to open the barrel Idrain openingand provide iiow from the barrel end across the plug and out the drainopening; no injection how, but a drain flow wherein the plug i's shiftedto close communication between the barrel inlet and outlet openings butleaving the barrel drain open; and no injection and no drain wherein theplug is shifted to close off the barrel outlet passage and also thebarrel drain.

17. A valve comprising a barrel having an inlet passage and also anoutlet passage, a movable plug in the barrel having at least onepassageway adapted to be selectively presented by the plug to providecommunication between said barrel inlet and outlet passages and to closeoff communication therebetween, said barrel having an opening at itsforward end and also a drain opening removed from the end, said plugextending over said barrel drain opening and also said plug having adrain passage open at the forward end of the plug and opening from theplug side to selectively communicate with the barrel drain opening uponshifting of the plug, and an injecting passageway carried by the barrelleading from said barrel outlet passage to discharge through the openend of said barrel, whereby upon suitable shifting of the plug in thebarrel, a selection of valve controls may be secured namely, aninjecting flow without drain into the barrel inlet passage across theplug passage and out the barrel outlet passage and through the injectingpassageway out the front end of the barrel, the barrel drain openingbeing closed; an injecting flow with drainage, the ow being the same asthe rst ow but with the plug shifted to open the barrel drain openingand provide ow from the barrel end across the plug and out the drainopening; no injection flow, but a drain flow wherein the plug is shiftedto close communication between the barrel inlet and outlet openings butleaving the barrel drain open; and no injection and no drain wherein theplug is shifted to close off the barrel outlet passage and also thebarrel drain, said first plug passage being confined t a groove in theperiphery of the plug.

NICHOLAS B. SALERNI.

